MEDICARE: DR. MICHAEL CANNON DPM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213ES0103X	Foot & Ankle Surgery Podiatrist	2169	TX
2	213E00000X	Podiatrist	2169	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1922494673
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL CANNON DPM

Provider Business Mailing Address
First Line	:	402 E ZAVALA ST STE 3
Second Line	:
City	:	CRYSTAL CITY
State	:	TX
Zip	:	78839-3337
Country	:	US
Telephone Number	:	830-448-5188
Fax Number	:	830-768-9248

Provider Business Practice Location Address
First Line	:	402 E ZAVALA ST
Second Line	:
City	:	CRYSTAL CITY
State	:	TX
Zip	:	78839-3337
Country	:	US
Telephone Number	:	720-252-7546
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/09/2015
Last Update Date	:	09/24/2025

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